胃切除术后胆道结石发生和再行腹腔镜手术治疗的影响因素研究  

Risk factors for biliary calculi formation and endoscopic surgery after gastrectomy

作　　者：錡和强 黄敏芳 洪自强 QI He-qiang;HUANG Min-fang;HONG Zhi-qiang(Department of General Surgery,The 909th Hospital of Logistic Support Force(Dongnan Hospital of Xiamen Unviersity),Zhangzhou 363000,China;Department of Dermatology,The 909th Hospital of Logistic Support Force(Dongnan Hospital of Xiamen Unviersity),Zhangzhou 363000,China)

机构地区：[1]中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)普外科,福建漳州363000 [2]中国人民解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)皮肤科,福建漳州363000

出　　处：《中国现代普通外科进展》2023年第4期283-287,共5页Chinese Journal of Current Advances in General Surgery

基　　金：福建省自然科学基金项目(2020J01133)。

摘　　要：目的:探讨胃切除术后胆道结石发生和再行腹腔镜手术治疗的影响因素。方法:回顾性分析中国人民解放军联勤保障部队第九〇九医院2010~2018年收治的497例胃切除术患者临床资料。单因素和多因素分析评价胃切除术后胆道结石发生的影响因素,比较开腹手术或腹腔镜手术治疗胆道结石的疗效。结果:单因素分析结果显示胃切除术后发生胆道结石的患者与未发生胆道结石的患者性别、BMI、糖尿病、高脂血症、病理类型、手术方式、淋巴结清扫数目、术后排空障碍差异均有统计学意义(P<0.05);多因素分析结果显示BMI、糖尿病、高脂血症、开腹手术、淋巴结清扫数目是胃切除术后患者胆道结石发生的危险因素(P<0.05)。胃切除术后胆道结石患者能否行腹腔镜手术,与胃切除范围、胃肿瘤病理类型、淋巴结清扫以及手术部位有关(P<0.05);多因素分析结果显示,全胃切除术、胃癌、淋巴结清扫是胃切除术后胆道结石患者腹腔镜手术失败的危险因素(P<0.05)。结论:胃切除术后患者胆道结石发生率较高,高BMI、糖尿病、高脂血症、开腹手术、淋巴结清扫数目是胃切除术后患者发生胆道结石的危险因素;此类患者虽可行腹腔镜手术,但全胃切除、胃癌、大范围淋巴结清扫是手术失败的危险因素,需根据患者自身情况制定合理手术方案。Objective:To investigate the factors influencing the occurrence of biliary calculi after gastrectomy,and to analyze the feasibility of laparoscopic surgery for biliary calculi.Methods:Clinical data of 497 patients undergoing gastrectomy admitted to the 909th Hospital of Logistic Support Force from 2010 to 2018 were retrospectively analyzed.Patients were signed informed consent,comply with the regulations of medical ethics.There were 301 males and 196 females.The ages ranged from 29 to 74,with a median age of 43.The enrolled patients were followed up for 3 years after surgery,98 cases of biliary calculi were in the observation group(n=98),and 399 cases without biliary calculi were in the control group(n=399).The effect of gastrectomy on lithiasis and endoscopic surgery was analyzed by univariate and multivariate methods.Results:Univariate analysis showed that there were statistically significant differences in gender,BMI,diabetes,hyperlipidemia,pathological type,surgical method,number of lymph node dissection and postoperative emptyation barriers between patients with and without biliary stones after gastrectomy(P<0.05).Multivariate analysis showed that BMI,diabetes,hyperlipidemia,laparotomy and number of lymph node dissection were risk factors for the occurrence of biliary stones after gastrectomy(P<0.05).Univariate analysis showed that in patients with recurrent biliary stones after gastrectomy,there were statistically significant differences in gastrectomy range,pathological type,number of lymph node dissection and surgical site between the laparotomy group and the endoscopic group(P<0.05).Multivariate analysis showed that total gastrectomy,gastric cancer and lymph node dissection were risk factors for failure of laparoscopic surgery for recurrent stones(P<0.05).Conclusions:After gastrectomy,patients have a high incidence of biliary calculi,and laparoscopic surgery can still be performed again,but affected by a variety of factors,a reasonable surgical plan should be formulated according to the individual situat

关 键 词：胆石症 胃切除术 腹腔镜检查 

分 类 号：R575.62[医药卫生—消化系统] R656.61[医药卫生—内科学]